I may say I had to reduce the allowance of alcohol for this patient to a minimum. He again received Thuja and later Lycopodium 30 and Urtica urens O. These kept him right, but indulgence in wine would always remind him of his troubles.
One great indication for Aesculus in these cases is “aggravation from walking.” Thuja has also the same aggravation. It is also indicated when vaccinosis is an element in a case. The 3 A.M. aggravation is a further indication for this antisycotic remedy.
CASE XIII.- A VERY CHRONIC CASE OF PILES.
Genl. R., aet. 56, consulted me first in June 1897. He had had piles for twenty years. They came first when he was stationed at Gibraltar. For the past three years they had given him much trouble, and in addition to the piles he had much mental depression. He had been treated with Iron, and one medical adviser suggested starvation diet, which did no good. There was a finally history of suppurating cervical glands, and the patient had been vaccinated four or five times. There was a history of attacks of tonsillitis, and I found the pharynx congested. Appetite good. His drink is whisky and soda. Has smoked a good deal, but does not smoke now to excess. Is troubled with flatulence. Pulse irregular and intermittent. Heart sounds normal. Is chilly, and feels the cold much. Feet cold and damp. Sweats easily. Sleep good. He is better in summer, worse in cold weather; worse by walking, and worse after stool. I found a large purple pile protruding on the right side of the anus. This was sore when he sat down.
I ordered a course of Sulphur 30, followed by Causticum 30, and a lotion of Hamamelis.
July 27, 1897. There is a good deal of protrusion. Piles come down on any extra very good deal of protrusion. Piles come down on any extra exertion. Spirits fair. Sleep very good. Pulse 84, regular.
Rx Acid nitricum 12 ter die. Bacillinum 100, every ten days at bedtime.
After this date the patient removed from London and I did not see him again till May 1901. He had had a very trying time the previous winter. Walking and standing bring on the prolapse. I found the piles again very much in evidence.
Rx AEsculus 3x thrice daily. Aescul. 30 at bedtime.
I explained to the patient that if he would let me follow up the treatment, I had no doubt I could do him permanent good, but not otherwise. To this he assented.
June 25, 1901. Piles rather worse. Tongue white. Has not slept so well. Good deal of depression.
Rx Nitric acid 30, I powder at bedtime.
Aug. 12, 1901. Much less discomfort. Walking does not cause so much prolapse. Less moisture.
Repeat. Oct. 17, 1901. Has been going on very well. Very much less protrusion. On examination I found the piles much smaller. The patient had had a severe bereavement and was much affected thereby.
Rx Ignat. 30 every two hours, and later Nit.ac. 30 again.
January 17, 1902. Bowels regular. Stools a trifle hard. There is prolapse after stool, but much less at other times.
Rx Lapsana com. O Three doses to go over two months.
March 20, 1902. Steady progress.
Repeat.
June 3, 1902. Going on well. Contracting power of sphincter better.
Repeat.
Oct. 22, 1902. Patient came to see me. I found the patient’s local condition very much improved.
Rx Ranunculus fic. O a dose every ten days.
January 5, 1903. Has had ups and downs, but he does not think, on the whole, he has had so little inconvenience for a long time as during this winter, whereas winter is always his worst time. D Repeat. June 20, 1903. He again came to town to see me. His condition was so much improved that he was able to walk about London as much as he wished, without fear of bringing on prolapse.
Repeat. Sept I, 1903. About the same.
Rx Aesculus hip. 30, once a week. November 28, 1903. Going on fairly well till February 20, when he caught a bad cold which upset him generally, but did not cause any aggravation of the piles.
Rx Lapsana O, once in ten days. February 24, 1904. I found the local condition very good.
Repeat. September 30, 1904. Going on well. I now interpolated three constitutional remedies, giving separately Thuja 30, Sulphur 30, and Bacillinum 30.
December 15, 1904 Going on well, till a fortnight ago, when he had some worry.
Rx Ranunculus fic. O. March I, 1905. Much better for the last course.
Repeat. May 16, 1905. Very much more comfortable. The local appearance is normal.
Repeat.
I still hear from this patient occasionally. He is in an entirely different condition from what he was when he first came to me. Except for a little inconvenience immediately after the action of the bowels, he is quite well. This for a case of twenty years’ standing is no small achievement. But it could not have been brought about without patient perseverance on the part of both patient and doctor. It should be remembered also that the general health of this patient improved, pari passu, with the improvement in the local condition. Indeed, in homoeopathy, we can only cure local states by curing the patient.
